儿童法乐氏四联症根治术连续70例无死亡的经验

EXPERIENCE OF 70 CONSECUTIVE CASES OF SURGICAL MANAGEMENT OF TETRALOGY OF FALLOT IN CHILDREN WITH NO OPERATIVE DEATH

本院从1990年7月至1991年5月连续70例儿童法乐氏四联症根治术无住院死亡。本组中婴幼儿占60%,行跨环补片者占47%。手术取得良好结果与下列措施密切有关:(1)手术技术的提高及手术组成员的相对稳定;(2)小体重(<8kg)或合并其它畸形患儿采用深低温停循环的方法;(3)深低温、低流量、高稀释技术的应用;(4)对跨瓣环补片的重症法乐氏四联症患儿,停机前及术后早期使用小剂量多巴胺;(5)体外循环均匀缓慢降温,晚复温且复温至较高水平(鼻温37～37.5℃,肛温35～36℃);(6)术后在保证热量的前提下,应用较大剂量呋喃苯胺酸(速尿)1～2mg/kg,排除体内多余水分,使循环尽早恢复或接近生理状态;(7)出院后连续服用强心利尿药3～6个月。

Seventy consecutive cases of tetralogy of Fallot in children had been treated surgically with no operative death from July 1990 to May 1991. Infants and neonates accounted for 60% and 47% of transannular patch in this series. The following measures were closely related to the satisfactory result: (1) improved surgical technique and relatively regular operative team, (2) profound hypothermia and circulatory arrest technique for patients less than 8 kg or associated with other complex defects, (3) profound hypothermia, low flow rate and high dilution technique, (4) low dose of dopamin in cases of transannular patch during weaning off of supporting circulation and in the early post-operative period, (5) even slow cooling and relatively later rewarming to a rather higher temperature (N 37～37.5℃, R 35～36℃) during extracorporeal circulation, (6) rather large dose of diuretics (1～2 mg/kg) in the post-operative period provided that sufficient calorie was maintained (7) digitalis and diuretic treatment for 3 to 6 consecutive months after discharge from the hospital.